Provider Demographics
NPI:1568148500
Name:WOODARD, MARISSA F (AGNP-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:F
Last Name:WOODARD
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BOULEVARD ST N
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31787-2645
Mailing Address - Country:US
Mailing Address - Phone:229-942-2288
Mailing Address - Fax:
Practice Address - Street 1:135 BOULEVARD ST N
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31787-2645
Practice Address - Country:US
Practice Address - Phone:229-942-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269097363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health